Node Necrosis Research Articles

Cervical nodal necrosis is an independent survival predictor in nasopharyngeal carcinoma: an observational cohort study.

PurposeMost nasopharyngeal carcinoma (NPC) patients present with locoregionally advanced disease at the time of diagnosis; however, there is a lack of consensus on specific prognostic factors potentially improving overall survival, especially in late-stage disease. Herein, we conducted a retrospective study to evaluate various potential prognostic factors in order to provide useful information for clinical treatment of T3/T4-stage NPC.Patients and methodsA total of 189 previously untreated NPC patients were enrolled in the current study. All patients received intensity-modulated radiotherapy. Survival, death, relapse-free survival (both local and regional), and metastasis were recorded during follow-up. Factors affecting patient survival were assessed by using univariate and multivariate analyses.ResultsThe median follow-up time was 69 months. The 5-year local-regional recurrence-free survival, distant metastasis-free survival, progression-free survival (PFS), and overall survival (OS) of the entire group were 89.8%, 71.5%, 66.3%, and 68.9%, respectively. Univariate analysis revealed significant differences in the 5-year PFS (58.5% vs 72.5%, P=0.015) and OS (59.5% vs 75.8%, P=0.033) rates of patients with and without cervical nodal necrosis (CNN). Subgroup analyses revealed that CNN was associated with poorer distant metastasis-free survival and PFS among patients with N2 stage (P=0.046 and P=0.005) and with poorer PFS among patients with T3 or III stage (all P=0.022). Multivariate analysis revealed CNN to be an independent prognostic factor for PFS and OS (PFS: adjusted hazard ratio, 1.860; 95% CI: 1.134–3.051; P=0.014; OS: adjusted hazard ratio, 1.754; 95% CI: 1.061–2.899; P=0.028).ConclusionCNN is a potential independent negative prognostic factor in NPC patients. Our results suggest that stratification of NPC patients based on their CNN status should be considered as part of NPC disease management.

High-Risk Factors of Parotid Lymph Node Metastasis in Nasopharyngeal Carcinoma: A Case-Control Study

Although parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma. This was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database. 20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients. PLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM.

High-risk factors of parotid lymph node metastasis in nasopharyngeal carcinoma: a case-control study.

BackgroundAlthough parotid-sparing IMRT decreased the dose distribution of parotid, parotid region recurrence has been reported. Prophylactic irradiation in parotid area would be necessary in patients with high risk of parotid lymph node metastasis (PLNM). This study was to detect the high-risk factors of PLNM in nasopharyngeal carcinoma.MethodsThis was a 1:2 case-control study. All patients in this study were newly diagnosed NPC with N2-3 classification from January 2005 to December 2012. Cases were 22 sides with ipsilateral PLNM. Controls were 44 patients who were randomly selected from N2-3 disease in database.Results20/1096 (1.82 %) NPC patients were found PLNM. Sum of the longest diameter for multiple lymph nodes (SLD) in level II was larger in case group than that in control group (6.0 cm vs. 3.6 cm, p = 0.003). Level II lymph node necrosis, level Va/b involvement, and rare neck areas involvement were more common in case group (p = 0.016, p = 0.034, and p < 0.001, respectively). RPN, level III, and level IV metastases showed no significant difference between the two groups. Multivariate analysis in logistic regression showed that only SLD ≥5 cm in II area (OR = 4.11, p = 0.030) and rare neck areas involvement (OR = 3.95, p = 0.045) were associated with PLNM in NPC patients.ConclusionsPLNM was an uncommon event in NPC patients. SLD ≥5 cm in level II and involvement in rare-neck areas may be potentially high-risk factors for PLNM. Sparing parotid in IMRT was not recommended for NPC patients with high risks of PLNM.

The crosstalk between Nodal and Tumor Necrosis factor alpha during luteolysis establishment in the mare

The crosstalk between Nodal and Tumor Necrosis factor alpha during luteolysis establishment in the mare

Clinicoradiological and Histopathological Comparative Study of Nodal Metastasis in Head and Neck Cancers

Background: Detection of regional lymph nodes in head and neck cancers greatly modifies the staging, treatment and prognosis of the patient and helps in planning the management of these patients. Methods: A prospective study was conducted in the Department of E.N.T., S.M.G.S. Hospital, G.M.C. Jammu, in collaboration with the Department of Radio diagnosis and Imaging, G.M.C. Jammu & Department of Radiation Oncology GMC, Srinagar from 2008 to 2012 in which patients attending / admitted in the Department of E.N.T., with cancer of head and neck, were assessed for lymph node metastasis (at different levels). 16 patients, all cases of squamous cell carcinoma head and neck, underwent appropriate neck dissections. The patients were examined clinically as well as with ultrasonography for detection of various enlarged lymph nodes at different levels. Computed tomography and magnetic resonance imaging were done, wherever indicated. Patients were subjected to fine needle aspiration cytology in cases of palpable lymph nodes. The removed lymph nodes were examined histopathologically. Results: The findings of clinical, radiological and histopathological studies were compared. We concluded that clinical palpation should be supplemented by ultrasonography in every case of head and neck cancer. However, since computed tomography picks up lymph nodes missed by ultrasonography in a significant number, is important in imaging primary tumour and picks up necrosis and extracapsular spread at the most, it should be included in each case of head and neck cancer. Conclusion: Magnetic resonance imaging being equivalent to computed tomography in picking up the nodes, but lagging behind the criteria such as picking up of nodal necrosis and extra capsular spread of lymph nodes, and is too costly, so may be included as an imaging modality wherever computed tomography is contraindicated.

Prognostic value of plasma fibrinogen level and cervical nodal necrosis in stage IVA/B nasopharyngeal carcinoma patients who had positive cervical nodal metastasis.

6039Background: Effective prognostic factors for stage IVA/B nasopharyngeal carcinoma (NPC) patients are limited. Fibrinolysis activation and cervical nodal necrosis (CNN) have been observed with a...

MP64-14 MAYO ADHESIVE PROBABILITY (MAP) SCORE IS ASSOCIATED WITH LOCALIZED RENAL CELL CARCINOMA PROGRESSION FREE SURVIVAL

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy III1 Apr 2016MP64-14 MAYO ADHESIVE PROBABILITY (MAP) SCORE IS ASSOCIATED WITH LOCALIZED RENAL CELL CARCINOMA PROGRESSION FREE SURVIVAL David Thiel, Andrew Davidiuk, Camille Meschia, Daniel Serie, Kaitlynn Custer, Steven Petrou, and Alex Parker David ThielDavid Thiel More articles by this author , Andrew DavidiukAndrew Davidiuk More articles by this author , Camille MeschiaCamille Meschia More articles by this author , Daniel SerieDaniel Serie More articles by this author , Kaitlynn CusterKaitlynn Custer More articles by this author , Steven PetrouSteven Petrou More articles by this author , and Alex ParkerAlex Parker More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.964AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Mayo Adhesive Probability (MAP) score is a validated scoring system derived from cross-sectional imaging measurements of perinephric fat thickness and stranding used to predict adherent perinephric fat. Given previously studied links between inflammation and RCC tumorigenesis, we hypothesized that higher MAP scores are associated with poor renal cell carcinoma (RCC) outcomes. We assessed the association of MAP score and progression free survival (PFS) in patients with RCC. METHODS We identified 456 patients from a prospective registry surgically treated for localized RCC between 2002 and 2014. A single reviewer calculated pre-operative MAP scores (0-5) for each patient with pre-operative imaging. Kaplan-Meier (KM) curves were utilized to estimate PFS. Univariate and multi-variate cox proportional hazards models were used to estimate the association of MAP score with risk of progression, with adjustment for covariates such as age, body mass index (BMI), and SSIGN (Size, Stage, Grade, Necrosis) scores. RESULTS Patients with high MAP scores (4-5) were more likely to be male, older, have higher BMI, and larger tumor size (all p <0.01). High MAP scores are not associated with nodal status (p=0.28), tumor necrosis (p=0.37), sarcomatoid differentiation (p=0.33), or type of surgery ((nephrectomy vs. partial nephrectomy) p=0.71). Of our total cohort, 405 patients had MAP scores and follow up data to assess PFS. Dichotomizing MAP scores into high (MAP 4-5) and low (MAP 0-3) yields a hazard ratio of 2.16 for the 4-5 group versus 0-3 group (95% CI: 1.15-4.06, p=0.017). Adjustment for BMI did not alter the association (BMI-adjusted HR = 2.20 [1.07-4.52], p=0.032). Of interest, the association with MAP and PFS remains consistent among pathologic stage T1 RCC patients (n=287 (HR = 3.46 [1.06-11.24], p=0.039). CONCLUSIONS High MAP scores (4-5) are associated with decreased PFS in patients surgically treated for clinically localized RCC compared to patients with lower MAP scores (0-3). These findings indicate RCC aggressiveness may be associated with perinephric fat thickness and stranding. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e835 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Thiel More articles by this author Andrew Davidiuk More articles by this author Camille Meschia More articles by this author Daniel Serie More articles by this author Kaitlynn Custer More articles by this author Steven Petrou More articles by this author Alex Parker More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The prognostic value of morphologic findings for lung squamous cell carcinoma patients

BackgroundNovel histopathological prognostic features for squamous cell carcinoma (SCC) of lung, such as tumor budding, mitotic rate, tumor stroma ratio, stroma type, stromal inflammation and necrosis, have been evaluated in the literature. In this study, the prognostic value of multiple morphological features is assessed in lung SCC. Materials and methodsThis study reports on seventy-six patients with lung SCC treated with complete surgical excision. Tumor size, tumor stage, lymph node status, lymphovascular invasion, histopathologic grade, mitotic count, necrosis, tumor budding, tumor stroma ratio, stroma type, stromal lymphoplasmacytic reaction and ratios of stromal plasma cells and their relationship with the prognosis were evaluated. Univariate and multivariate analyses were performed for histopathological markers for local disease free survival (LDFS), distant disease free survival (DDFS), overall disease free survival (ODFS) and overall survival (OS). ResultsThe univariate prognostic analysis of the pathological factors revealed that the pathological stage (OS: p=0.001, DDFS: p=0.040), lymph node metastases (OS: p=0.013), mitotic index (OS: p=0.026), tumor necrosis (DDFS: p=0.013, ODFS: p=0.021) and tumor size (OS: p=0.002) had a prognostic significance. The multivariate analysis demonstrated that the pathological stage (OS: p=0.021), tumor size (OS: p=0.044), lymph node status (DDFS: p=0.019, ODFS; p=0.041) and necrosis (ODFS: p=0.048) were independent prognostic factors. ConclusionsAlthough many histopathological factors have recently been proposed as important prognostic markers, we only found significant results for mitotic index and tumor necrosis, as well as the well known parameters such as tumor stage and lymph node status. To the best of our knowledge, this is the first study evaluating such a wide range of morphological prognostic factors in lung SCC.

2838 The characteristics and prognostic value of lymph node necrosis in nasopharyngeal carcinoma at MRI

2838 The characteristics and prognostic value of lymph node necrosis in nasopharyngeal carcinoma at MRI

Accuracy of Preoperative Imaging in Detecting Nodal Extracapsular Spread in Oral Cavity Squamous Cell Carcinoma.

The increasing impact of diagnosing extracapsular spread by using imaging, especially in patients with oropharyngeal squamous cell carcinoma, highlights the need to rigorously evaluate the diagnostic accuracy of imaging. Previous analysis suggested 62.5%-80.9% sensitivity and 60%-72.7% specificity. Our goals were to evaluate the accuracy of imaging in diagnosing extracapsular spread in a cohort of patients with oral cavity squamous cell carcinoma (pathologic confirmation of extracapsular spread routinely available), as a proxy for oropharyngeal squamous cell carcinoma, and to independently assess the reliability of imaging features (radiographic lymph node necrosis, irregular borders/stranding, gross invasion, and/or node size) in predicting pathologically proven extracapsular spread. One hundred eleven consecutive patients with untreated oral cavity squamous cell carcinoma and available preoperative imaging and subsequent lymph node dissection were studied. Two neuroradiologists blinded to pathologically proven extracapsular spread status and previous radiology reports independently reviewed all images to evaluate the largest suspicious lymph node along the expected drainage pathway. Radiologic results were correlated with pathologic results from the neck dissections. Of 111 patients, 29 had radiographically determined extracapsular spread. Pathologic examination revealed that 28 of 111 (25%) had pathologically proven extracapsular spread. Imaging sensitivity and specificity for extracapsular spread were 68% and 88%, respectively. Radiographs were positive for lymph node necrosis in 84% of the patients in the pathology-proven extracapsular spread group and negative in only 7% of those in the pathologically proven extracapsular spread-negative group. On logistic regression analysis, necrosis (P = .001), irregular borders (P = .055), and gross invasion (P = .068) were independently correlated with pathologically proven extracapsular spread. Although the specificity of cross-sectional imaging for extracapsular spread was high, the sensitivity was low. Combined logistic regression analysis found that the presence of necrosis was the best radiologic predictor of pathologically proven extracapsular spread, and irregular borders and gross invasion were nearly independently significant.

Imaging Anatomy of Waldeyer's Ring and PET/CT and MRI Findings of Oropharyngeal Non-Hodgkin's Lymphoma.

This study was conducted to analyze positron emission tomography (PET) / computed tomography (CT) and magnetic resonance imaging (MRI) performance with oropharyngeal non-Hodgkin's lymphoma (ONHL). The complete image data of 30 ONHL cases were analyzed, all patients were performed PET / CT and MRI examination before the treatment, with the time interval of these two inspections not exceeding 14 days. The distribution, morphology, MRI signal characteristics, enhancement feature, standardized uptake value (SUV) max value and lymph node metastasis way of the lesions were analyzed. Among the 30 cases, 23 cases were derived from the B-cell (76.7%), 5 cases were derived from the peripheral T cells (16.7%) and 2 cases were derived from the NK/T cells (6.7%). 19 cases exhibited the palatine tonsil involvement (63.3%). As for the lesion appearance, 10 cases appeared as mass, 8 cases were the diffused type and 12 cases were the mixed type. 25 cases exhibited the SUVmax value of PET / CT primary lesions as 11 or more (83.3%). MRI showed that all patients exhibited various degrees of parapharyngeal side-compressed narrowing, but MRI still exhibited the high-signal fat, and the oropharyngeal mucosa was intact. 25 cases were associated with the neck lymph node metastasis, among who 22 cases had no necrosis in the metastatic lymph nodes, while the rest 3 cases exhibited the central necrosis in the metastatic lymph nodes. PET / CT and MRI have important value in diagnosing and determining the lesion extent of ONHL.

Prognostic Value of Cervical Nodal Necrosis in Nasopharyngeal Carcinoma: Analysis of 1800 Patients with Positive Cervical Nodal Metastasis at MR Imaging.

To evaluate the prognostic value of cervical nodal necrosis (CNN) in patients with nasopharyngeal carcinoma (NPC) with magnetic resonance (MR) imaging. This was an institutional review board-approved retrospective study of 1800 patients with newly diagnosed stage T1, 4N1, 3M0 NPC who were treated with definitive radiation therapy, with or without chemotherapy, between January 2007 and December 2009; the requirement to obtain informed consent was waived. MR images were reviewed to assess lymph node status, and patients were divided into CNN and non-CNN groups. The overall survival, disease-free survival, regional relapse-free survival (RRFS), and distant metastasis-free survival (DMFS) were calculated with the Kaplan-Meier method, and differences were compared by using the log-rank test. The incidence of CNN was 44.0% (792 of 1800). After the median follow-up period of 53 months, the 5-year overall survival, disease-free survival, RRFS, and DMFS rates of the CNN and non-CNN groups were 78.8% and 91.8%, 78.2% and 91.2%, 78.6% and 91.8%, and 78.4% and 91.6%, respectively (for all rates, P < .001). The distant metastasis rate was 18.7% (148 of 792) for the CNN group versus 4.6% (46 of 1008) for the non-CNN group (P < .01). Subgroup analysis revealed similar survival outcomes between stage N1 disease with CNN and stage N2 disease without CNN, stage N2 disease with CNN, and stage N3 disease regardless of CNN. CNN, T stage, N stage, age older than 44 years, and male sex were significant independent negative prognostic factors for overall survival, disease-free survival, RRFS, and DMFS. CNN is an independent negative prognostic factor in patients with NPC, and it may be appropriate to investigate whether N stage should be upgraded by one level in patients with CNN.

Correlation of various histopathologic prognostic factors with Nottingham prognostic index and microvessel density in invasive breast carcinoma: A study of 100 cases.

Nottingham prognostic index (NPI) is a widely used integrated prognostic variable in patients with breast cancer. NPI has been correlated with tumor size, grade, lymph node stage and patient survival. The present study aimed at evaluating and correlating the various clinical and pathologic features of breast carcinoma with NPI. This study included 100 consecutive cases of primary breast carcinoma over a period of 2 years. Demographic data was noted and histomorphological features like tumor size, grade, lymph node involvement, necrosis, vascular invasion etc., were assessed. NPI was calculated as reported in the literature. Immunohistochemical staining for hormone receptors and CD34 (to calculate microvessel density [MVD]) was performed. Statistical analysis was used for correlation. Of the 100 cases, 54% of the tumors were in T2 tumor size category (2-5 cm) and lymph node metastasis in 48% of the cases. NPI ranged from 2.3 to 7.3 with 54% of the cases in the intermediate NPI group (3.41-5.4). The mean MVD was 160.93 (±69.4/mm2). On statistical analysis, tumor size and grade, lymph node stage, mitotic rate, nuclear pleomorphism, necrosis and MVD showed a correlation with NPI (P < 0.05). NPI is an important and useful prognostic indicator for breast cancer patients, which shows the correlation with other histomorphological prognostic features as well.

A rare case of lymph node infarction

Lymph node infarction refers to a syndrome of coagulative necrosis of lymph node that is frequently associated with concurrent or subsequent development of malignant lymphoma. Lymph node infarction is a very rare entity among the various pathologies involving the lymph node. We hereby present a case report of lymph node infarction in a 40 year old female patient who presented with sub mandibular swelling.

Diagnostic accuracy of the clinical and CT findings for differentiating Kikuchi's disease and tuberculous lymphadenitis presenting with cervical lymphadenopathy.

To determine the optimal clinical and CT findings for differentiating Kikuchi's disease (KD) and tuberculous lymphadenitis (TB) in patients presenting with cervical lymphadenopathy. From 2006 to 2010, 87 consecutive patients who were finally diagnosed with KD or TB were enrolled. Two radiologists performed independent analysis of contrast-enhanced neck CT images with regard to the involvement pattern, nodal or perinodal changes, and evidence of the previous infection. Significant clinical and CT findings of KD were determined by statistical analyses. Of the 87 patients, 27 (31%) were classified as having KD and 60 (69%) as having TB. Statistically significant findings of KD patients were younger age, presence of fever, involvement of ≥5 nodal levels or the bilateral neck, no or minimal nodal necrosis, marked perinodal infiltration, and no evidence of upper lung lesion or mediastinal lymphadenopathy. The presence of four or more statistically significant clinical and CT findings of KD had the largest area under the receiver-operating characteristic curve (A z = 0.861; 95% confidence intervals 0.801, 0.909), with a sensitivity of 89% and specificity of 83%. CT can be a helpful tool for differentiating KD from TB, especially when it is combined with the clinical findings.

Detecting Mycobacterium tuberculosis complex DNA, based on post-mortem examination of hilar lymph nodes with real-time PCR: initial study.

According to the WHO, almost a third of the world population are thought to be infected with Mycobacterium tuberculosis. Some studies of the prevalence of latent tuberculosis infection (LTBI) have already been performed in Poland, showing that almost a quarter of the Mazovia population could be infected. It also indicated a higher prevalence of LTBI among seniors. Those studies were based on indirect diagnostic methods. We randomly collected hilar lymph nodes from decedents aged 40 years and older during post-mortem examination. We excluded patients with previous confirmed tuberculosis. In addition, an autopsy was performed in all patients. Finally, we used real-time PCR Xpert MTB/RIF (Cepheid, USA) for the specific capture of mycobacterial DNA. Twenty-two of 23 patients had a negative result of the real-time PCR examination and no signs of caseous necrosis in hilar lymph nodes. We found the only positive sample in a patient with histopathological signs of tuberculosis (the presence of caseous necrosis in the specimens obtained from lymph nodes and lung). Due to the change of cartridges from version G3 to G4, further reactions were inhibited and no more post-mortem samples were tested. Real-time PCR Xpert MTB/RIF was capable of detecting M. tuberculosis complex DNA in a patient with tuberculosis recognised on autopsy. In the remaining patients, no M. tuberculosis complex DNA was found, in accordance with negative results of histological examination. Since the technology of cartridges has changed, it is no longer possible to use real-time PCR Xpert MTB/RIF (Cepheid USA) on post-mortem material.

Evaluation of clinical and sonographic features in 55 children with tularemia.

The aim of this study was to determine the clinical characteristics and sonographic features of lymphadenopathy (LAP) and to evaluate the treatment modalities and treatment outcomes in children with tularemia. Demographic characteristics, ultrasonographic and physical examination findings, and treatment outcomes in 55 tularemia patients (24 male and 31 female) with a mean age of 10.8 ± 4.0 years were analyzed retrospectively. Lymph node necrosis was classified in three stages based on ultrasound findings-stage 1, cortical microabscesses; stage 2, cortical and medullar abscesses; stage 3, total necrosis of the lymph node. In total, 50 (90%) of the patients had oropharyngeal, four (8%) had glandular, and one (2%) had oculoglandular tularemia. The most common symptoms were sore throat (67%) and fever (64%). LAP was the most frequently (100%) observed sign. Abscess formation was noted in 36 (65%) patients, of which seven (19%) were sonographically classified as stage 1, 20 (55%) as stage 2, and nine (26%) as stage 3. There was a statistically significant correlation between delayed treatment and stage of abscess formation in lymph nodes (p<0.05). Treatment failure was observed in 24 (44%) patients. There was no significant correlation between treatment regimen and treatment failure (p>0.05). In all, nine (16%) of the patients did not respond to medical treatment, and surgical intervention was required. Tularemia should be considered in the differential diagnosis of children presenting with unexplained fever, sore throat, and cervical LAP in endemic areas. Sonographic findings may be useful in the evaluation and staging of this infection.

Chest CT findings in EBUS-TBNA-proven anthracosis in enlarged mediastinal lymph nodes.

We demonstrate the multislice computed tomography (MSCT) findings of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA)-proven hilar and mediastinal lymph node enlargement with signs of anthracosis. 53 enlarged lymph nodes in 39 patients (28 male, 11 female) with EBUS-TBNA-confirmed anthracosis were analyzed retrospectively. The mean short axis diameter of the enlarged lymph nodes with signs of anthracosis was 13.7 mm. Lymph nodes most often showed an oval shape (84 %) and were well defined in 66 % of cases. Lymph node confluence was observed in 32 % of cases. Calcifications were documented in 24.5 % of cases. Contrast enhancement and fatty involution were seen seldom (3.8 %). Lymph node necrosis was not seen. Lymph node anthracosis may be found most often in enlarged, well defined lymph nodes with an oval shape, frequently associated with confluence and calcifications.

Lymphoepithelial carcinoma of the salivary gland: morphologic patterns and imaging features on CT and MRI.

Lymphoepithelial carcinoma is a rare salivary gland lesion. We retrospectively reviewed CT and MR imaging features of salivary gland lymphoepithelial carcinoma to determine their imaging features and morphologic patterns. The clinical data, CT, and MR imaging findings of 28 patients with histologically proved lymphoepithelial carcinoma of the salivary gland were retrospectively reviewed. Morphologic patterns of the lesions were categorized into 3 types on the basis of margin and shape. There were 17 men and 11 women with a mean age of 39.3 years; 96.4% of patients were positive for Epstein-Barr virus both on histologic staining and Epstein-Barr virus serology. Tumors were parotid in 18 patients, submandibular in 8 patients, sublingual in 1 patient, and palatal in 1 patient. Most tumors (57.1%) manifested as a partially or ill-defined mass with a lobulated or plaque-like shape. Homogeneous enhancement was found in 16 patients, while heterogeneous enhancement was found in 12, including 4 patients with intratumoral necrosis. Invasion into adjacent structures was found in 5 patients; 60.7% of patients exhibited abnormal lymph nodes, with nodal necrosis in 3 patients. The characteristic lobulated or plaque-like shape, with a partially or ill-defined margin, of a salivary gland mass associated with ipsilateral lymphadenopathy may suggest a preoperative diagnosis of lymphoepithelial carcinoma.

Clinicopathological Characteristics and Prognosis-Related Factors of Resectable Pancreatic Neuroendocrine Tumors

ObjectiveThe purpose was to describe the clinicopathological characteristics of pancreatic neuroendocrine tumors (pNETs) and evaluate prognosis-related factors in potentially resectable pNETs.MethodsThe clinical data of 104 patients with pNETs who underwent surgery were retrospectively analyzed.ResultsThe mean (SD) age was 49.8 (14.6) years. The percentages of TNM stages I, II, III, and IV tumors were 25.0%, 44.2%, 22.1%, and 8.7%, respectively. Twenty-seven cases were functional. Nonfunctional pNETs were more common in patients with large tumors, advanced age, higher mitotic count, neural invasion, extrapancreatic organ invasion, liver metastases, and advanced staging (P < 0.05). The 5-year overall survival rate was 93%. The relapse rate was 28.6% (28/98), and the mean (SD) relapse time was 38.7 (31.7) months. Reduced survival rate was associated with older patients (>60 years) (P = 0.026), patients with a higher Ki-67 index (>2%) (P = 0.024), regional lymph node metastases (P = 0.033), liver metastases (P = 0.015), neural invasion (P = 0.017), necrosis (P = 0.042), and major vascular invasion (P = 0.023). Age of more than 60 years (P = 0.047; hazard ratio [HR], 5.2), major vascular invasion (P = 0.030; HR, 5.8), and a Ki-67 index greater than 2% (P = 0.008; HR, 10.3) were independent predictors.ConclusionsNonfunctional pNETs were more common with aggressive clinical presentation. Age of more than 60 years, major vascular invasion, and a Ki-67 index greater than 2% were independent predictive factors. Patients who underwent a potentially curative resection seemed to achieve long-term survival.